Long-Term Evaluation of Bone Cementoplasty in Multiple Myeloma Patients

INTRODUCTION

Cementoplasty is used to treat lytic bone lesions that are critically located, painful, or fractured. It is particularly useful in multiple myeloma. Hematological therapeutic improvements have considerably extended the life expectancy of myeloma patients. This study aimed to evaluate the long-term clinical efficacy, mechanical stability, and safety outcomes of cementoplasties in myeloma.

MATERIAL AND METHOD

This was a single-center retrospective descriptive study of vertebral and pelvic bone cementoplasties in a tertiary care teaching hospital in patients who were followed up for > 5 years. All cementoplasties performed between January 2012 and December 2017 were reviewed, and the patients who underwent cementoplasty for myeloma were included. Patients who died less than 5 years after the intervention were excluded. Patients with a survival of > 5 years and control imaging by MRI or CT scan > 5 years after the procedure were included. All images were reviewed and blinded to the patients' clinical status. The presence of new fractures at the cemented sites or adjacent bone levels was evaluated.

RESULTS

During the inclusion period, 2085 patients underwent cementoplasty, including 154 patients with myeloma. Seventy-six patients survived for at least 5 years after the procedure, and 47 patients (33 men [70%]; median age 62.2 years [IQR 53.8; 69.6]) underwent follow-up imaging at 5 years or more after the procedure. The median bone marrow aspirate plasmacytosis was 16% (IQR: 7.0-25.8) and the immunoglobulin isotypes were as follows: Light Chain only 35% (Kappa 69%, Lambda 31%), IgG 51%, and IgA 14%. Of the 19/47 patients with available cytogenetic data, 2 (11%) were high-risk and 17 (89%) were standard risk. The ISS was I in 11(41%), II in 10 (37%), and III in 6 (22 %) patients (20 missing). LDH levels were elevated in 15 patients (75%) (27 missing). One patient had an extramedullary plasmocytoma. Thirty patients (64%) underwent autologous hematopoietic stem cell transplantation. At the time of the analysis, 30 patients (64%) relapsed at least once. The median progression-free survival was 59 months (95% CI 41-82), the median overall survival was not reached, the mean was 164 months (95% CI 138-190). The patients underwent 74 procedures at 142 cemented sites comprising 9 cervical, 59 thoracic, 61 lumbar vertebrae, 11 pelvic girdle cementoplasties, and 2 other sites. Among the cemented sites, 101 (71%) were demineralized fractures, and 41 (29%) were osteolytic lacunae. No serious procedure-related adverse effects were observed. Only 4 cemented sites (2.8%) were affected by fracture recurrence during the follow-up period, including two thoracic and two lumbar vertebrae. These recurrences were all observed in women, and no other predictive factors for fracture recurrence were identified. Thirteen patients had vertebral fractures adjacent to the cemented site (16/129 vertebrae (12.4%)). Intervertebral disc cement leak was significantly associated with the occurrence of vertebral fracture at the adjacent level (31% vs. 8.8%, p = 0.022). A potential radiological dorso-lumbar posture modification is reported.

CONCLUSION

Bone cementoplasty for myeloma is a durable treatment, with only 2.8% fracture recurrence at five years in our cohort. Long-term follow-up revealed up to 12% of vertebral fractures adjacent to cemented vertebrae, which may be eligible for new cementoplasty. Prophylactic cementoplasty of the adjacent vertebra can be performed in cases of cement disc leakage in the context of myeloma.

Garderet:Sanofi: Honoraria; BMS: Honoraria; Janssen: Honoraria. Choquet:Kite-Gilead: Honoraria.